Riverside Surgery

Updated 31 October 2016

Riverside Surgery is a GP practice located in purpose built premises on the outskirts of High Wycombe town centre in Buckinghamshire. Riverside Surgery is one of the practices within Chiltern Clinical Commissioning Group (CCG) and provides general medical services to approximately 9,800 registered patients. A CCG is a group of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

All services are provided from:

• Riverside Surgery, George Street, High Wycombe, Buckinghamshire HP11 2RZ.

The practice has a mixed patient population. Patients registered at the practice are from a number of different ethnic backgrounds, approximately 30% of patients have an Asian background and 7% have a Black background. In addition, High Wycombe has a growing Eastern European community; this is reflected in the patient population list as there is a growing number of Polish and Romanian patients registered with Riverside Surgery. This ethnic mix is consistent with the variety of cultures in High Wycombe. There are a large proportion of the patients who speak English as a second language, a high prevalence of long term conditions and a large percentage of patients are housebound.

According to data from the Office for National Statistics, Buckinghamshire has minimal economic deprivation. However, Riverside Surgery is located within a pocket of high deprivation. The practice has a highly transient patient population; people living in more deprived areas tend to have greater need for health services and people outside of the country for long periods often has an impact on screening and recall programmes.

The age distribution of the registered patients is largely similar to the national averages. Although there is a slightly higher than average number of patients aged between 20 and 34 years of age.

Over the previous three years Riverside Surgery has seen a significant amount of change, including changes of key members of staff including GP Partners, the practice manager and departmental managers.

The practice comprises of three GP Partners (all female), four salaried GPs (three female and one male) and three GP Registrars (two female and one male). Riverside Surgery is a training practice for GP Registrars. GP Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine. In addition, a pharmacist advisor recently joined Riverside Surgery.

The all-female nursing team consists of one advanced nurse practitioner, three practice nurses and a health care assistant who also performs phlebotomy duties.

Three departmental managers (with oversight from the GP Partners) are supported by a team of reception, administrative and secretarial staff who undertake the day to day management and running of Riverside Surgery.

Riverside Surgery is open between 8am and 6.30pm Monday to Friday (appointments between 8.40am and 5.50pm). Each week extended hours appointments were available, once a week the practice was open between 7am and 8am, the following week the practice was open one evening a week between 6.30pm and 7.30pm. Riverside Surgery was also open every Saturday morning for pre-bookable appointments between 8.30am and 11.30am. The duration of the Saturday morning clinic had been increased following a successful trial and patient feedback.

The practice has opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Advice on how to access the out-of-hours service is clearly displayed on the practice website, on both practices door and over the telephone when the surgery is closed.

Updated 31 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Riverside Surgery in High Wycombe, Buckinghamshire on 16 September 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Feedback from patients relating to the quality of care was in line with local and national averages. Written and verbal feedback collected during the inspection highlighted the new appointment system and new telephone system had significantly improved access.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, community specific training to support the large proportion of practice patients who were Muslim.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.

• It was evident the practice had gone through a period of transition including a significant number of key staff changes and the adoption of a non-traditional staff model. Despite this we saw evidence of team working across all roles.

The areas where the provider should make improvement are:

• Continue to monitor access to appointments to ensure patients are able to contact the practice to make appointments without difficulty.

• Ensure an action plan for learning disability reviews with a view to increase the number of annual health checks is monitored through the practice meetings.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 31 October 2016

The practice is rated as good for the care of people with long-term conditions.

• The number of patients registered at Riverside Surgery with a long-standing health condition was higher than local and national averages. For example, 59% of Riverside Surgery patients had a long-standing health condition, this was higher than the local CCG average (52%) and national average (54%). Specifically, the prevalence of diabetes within the patient population was higher than local and national averages. Approximately 8% of Riverside Surgery patients have diabetes, higher than both the local CCG prevalence (6%) and national prevalence (6%).

• GP’s and nurses had additional training and lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice made full use of e-mail consultations and telephone consultations to help diabetic patients manage their condition without having to attend the practice.

• Performance for diabetes related indicators showed Riverside Surgery had achieved 94% of targets which was similar when compared to the CCG average (93%) and higher when compared to the national average (89%).

• Performance for Chronic Obstructive Pulmonary Disease (known as COPD, a collection of lung diseases including chronic bronchitis and emphysema) indicators showed the practice had achieved 100% of targets which was similar when compared to the CCG average (99%) and higher when compared to the national average (96%).

• Longer appointments and home visits were available when needed.

Updated 31 October 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• Immunisation rates were in line with local averages and higher than national averages for all standard childhood immunisations. The practice was working with local midwives to increase immunisation rates for specific pregnancy related immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 81%, which was similar when compared to the CCG average (84%) and the national average (82%).

• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 31 October 2016

The practice is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• Riverside Surgery was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice identified if patients were also carers; information about support groups was available in the waiting areas.

• Over the three previous flu campaigns, Riverside Surgery had opportunistically screened patients for atrial fibrillation who were attending the practice for their influenza vaccination. Atrial fibrillation (AF) is an irregular pulse, could be a sign of an abnormal heart rhythm and is one of the most common forms of abnormal heart rhythm and a major cause of stroke. Opportunistic screening at flu clinics alongside other diagnostic tests had increased the number of confirmed AF diagnoses cases from 26 patients in 2013/14, to 39 patients in 2014/15 and more recently 43 patients in 2015/16.

• The practice worked with the multi-disciplinary teams in the care of older vulnerable patients.
• All of nationally reported data showed that outcomes for patients for conditions commonly found in older patients were higher when compared with local and national averages. For example, Riverside Surgery’s performance for osteoporosis (osteoporosis is a condition that weakens bones, making them fragile and more likely to break) indicators was higher than both the local and national averages. The practice had achieved 100% of targets which was higher when compared to the CCG average (96%) and the national average (81%).

Updated 31 October 2016

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• There was a range of appointments including early morning, evening and Saturday morning appointments. These appointments were specifically for patients not able to attend outside normal working hours but there was no restrictions to other patients accessing these appointments.

• Phlebotomy services were available at the practice which meant patients did not have to attend the hospital for blood tests.

Updated 31 October 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 92% of people experiencing poor mental health had a comprehensive care plan documented in their record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate. This was similar when compared to the CCG average (89%) and national average (88%).

• 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was similar when compared to the local CCG average (86%) and the national average (84%).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice was also working towards becoming a dementia friendly practice.

• One of the GPs from Riverside Surgery was leading a community engagement project for dementia awareness within the BME community. (BME refers to Black and Minority Ethnic or Black, Asian and Minority Ethnic, terminology normally used in the UK to describe people of non-white descent.) Part of the project involved increasing the awareness of dementia in BME communities initially in the High Wycombe, Chesham and Aylesbury Vale area whilst seeking the views of communities, patients and carers. This project also identified the barriers when seeking advice and support, treatment and services. The GP had also engaged with focus groups via local community interest groups, local faith groups and via BME radio stations to help de-stigmatise dementia in BME communities and support patients to seek an early diagnosis of dementia and plan for their future.

Updated 31 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• All patients with a learning disability were invited to attend the practice for an annual health check. In 2014/15, Riverside Surgery had carried out annual health checks for 73% of people with a learning disability. Data for 2015/16 showed fewer health checks had been completed as 58% people with a learning disability had a health check.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.